Clinical Investigation

Kidney International (1984) 25, 653–659; doi:10.1038/ki.1984.70

Dialysis-associated ischemic heart disease: Insights from coronary angiography

Stephen G Rostand1, Katharine A Kirk1 and Edwin A Rutsky1

1The Nephrology Research and Training Center, Division of Nephrology, Department of Medicine, and the Department of Biostatistics, The University of Alabama in Birmingham, and the Veterans Administration Medical Center, Birmingham, Alabama

Correspondence: Dr S G Rostand, Division of Nephrology, Department of Medicine, University of Alabama in Birmingham, Birmingham, Alabama 35294, USA

Received 3 June 1983; Revised 6 September 1983.

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Abstract

Dialysis-associated ischemic heart disease: Insights from coronary angiography. We reviewed the records of 44 dialysis patients who had undergone one or more coronary angiograms to determine the frequency with which symptomatic ischemic heart disease (IHD) and significant coronary artery narrowing coincided and to determine those factors which were associated with the coronary atherosclerotic process. Thirty-four patients were catheterized for angina pectoris or myocardial infarction. Of this group, 53% were found to have significant narrowing of coronary arteries. This group was older than the group with trivial or no coronary artery occlusion and their duration of dialysis was shorter. All the patients with significant coronary occlusion were white and the majority were adult males. Discriminant function analysis revealed that the presence of significant coronary artery occlusion could be predicted with high sensitivity and specificity by the following variables: older age, white race, male sex, the presence of symptomatic IHD prior to the onset of dialysis, increased total serum cholesterol, abnormal left ventricular wall motion, and reduced alkaline phosphatase. We also found that the occurrence of symptomatic IHD far exceeded the presence of significant atherosclerotic coronary artery narrowing. We suggest that this may result from several dialysis-associated alterations in oxygen delivery and myocardial oxygen consumption.

Cardiopathie ischémique associée à la dialyse: Données de l'angiographie coronarienne. Nous avons revu les dossiers de 44 malades hémodialysés qui avaient eu une ou plusieurs coronarographies afin de déterminer la fréquence avec laquelle une cardiopathie ischémique symptomatique (IHD) et une sténose significative d'une artère coronaire ont coïncidé, et afin de déterminer les facteurs qui étaient associés avec le processus d'artériosclérose coronaire. Trente-quatre malades ont été cathétérisés en raison d'une angine de poitrine ou d'un infarctus du myocarde. Dans ce groupe, 53% avaient une sténose significative des artères coronaires. Ce groupe était plus âgé que le groupe avec une sténose de l'artère coronaire minime ou nulle, et la durée en dialyse était plus courte. Tous les malades avec une obstruction coronaire significative étaient blancs, et la majorité était des mâles adultes. Une analyse des fonctions discriminantes a révélé que la présence d'une occlusion significative d'une artère coronaire pouvait être prédite avec une sensibilité et une spécificité élevées par les variables suivantes: âge plus grand, race blanche, sexe masculin, présence d'IHD symptomatique avant la mise en hémodialyse, augmentation du cholestérol sérique total, cinétique de la paroi ventriculaire gauche anormale, et réduction des phosphatases alcalines. Nous avons également trouvé que la survenue d'une IHD symptomatique dépassait de loin la présence d'une sténose artérioscléreuse coronaire significative. Nous suggérons que cela pourrait résulter de plusiers altérations, associées à la dialyse, dans l'apport en oxygène et la consommation en oxygène du myocarde.

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